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PubMed2001

Cranial thickness in relation to age, sex and general body build in a Danish forensic sample.

The cranial thickness was measured in 64 individuals (43 males, 21 females) autopsied at our institute. The thickness was measured by taking a biopsy with a trephine at four specific locations on the skull. Complete medical records and pathologic autopsy results were available. While none of the individuals had suffered from diseases affecting bone or bone metabolism as such, a large sub group consisted of individuals with a history of, and autopsy finds consistent with, chronic substance and alcohol abuse. There was no statistically significant difference in cranial thickness measures between this group and the rest of the material. Subsequent analyses failed to reveal any correlations between the cranial thickness and sex and age and height and weight of the individual. This is in accordance with most earlier studies, which likewise show no correlation, or only very faint trends, between cranial thickness and these parameters. This study, thus, adds to other studies showing that cranial thickness cannot be used in aging or sexing human remains. Likewise, in a forensic pathological setting, cranial thickness cannot be inferred from the individuals stature and build, which may be an issue in cases of interpersonal violence with cranial trauma.

Adolescent↗
PubMed2003

Plasma cell myeloma marrow diagnosis including morphologic and phenotypic features.

This article emphasizes both the morphologic and phenotypic features of the bone marrow in plasma cell myeloma. It details the morphologic features of both trephine biopsies and marrow aspirations. It emphasizes the salient phenotypic features of marrow myeloma cells, in contrast with normal plasma cells. The myeloma cell phenotype is discussed from the perspective of both tissue section immunohistochemistry (IHC) and flow cytometry (FACS analysis). The specific criteria for myeloma diagnosis are discussed and illustrated in Figures 1-12. Finally, the emphasis is on the key morphologic and phenotypic diagnostic criteria of each of the plasma cell neoplasms.

Biomarkers, Tumor↗
PubMed1998

Dental disease in geriatric horses.

The dental management of geriatric horses can be a rewarding challenge to the practitioner. Owners become dissatisfied when their expectations are unrealistic. Consequently, communication between the owner and the practitioner is essential prior to the start of any dental procedure in a geriatric horse. Owners often expect the practitioner to correct what has been neglected for years. It is critical that the owner understand the possible complications associated with dental procedures and that some procedures (e.g., trephination) may necessitate protracted care. Often, when a tooth has been removed, there is a need for more frequent masticatory examinations to curtail any potential problems (i.e., development of step mouth). The owner needs to be aware of the extra dental maintenance costs that must be included in the upkeep of the horse.

Aging↗
PubMed1991

Standing surgery and procedures of the head.

Although most surgical procedures of the head are technically easier to perform with the horse under general anesthesia, other factors will influence whether a surgical procedure is performed with the horse standing or recumbent under the influence of general anesthesia. The accessibility of the head lends itself to many standing surgical procedures if the proper combination of analgesia and physical and chemical restraint is used. Traumatic injuries of the head (lacerations, facial bone fractures, and oral fractures) may involve vital structures, and a thorough examination is indicated. Failure to treat a traumatic injury may result in facial deformity, bony sequestra, paranasal sinusitis, salivary-cutaneous fistula, cutaneous fistulas into a nasal passage or paranasal sinus, nasal septal deformities, and ocular dysfunction. Proper management of these injuries typically results in a cosmetic outcome because of the head's abundant blood supply. Other surgical procedures that can be performed in the standing horse include centesis and trephination of the paranasal sinuses, certain dental procedures, alar fold stabilization, and extirpation of epidermal inclusion cysts of the nasal diverticulum.

Analgesia↗
PubMed1988

[Trans-triquetral triquetral-lunate arthrodesis].

Transtriquetral triquetro-lunate arthrodesis is an original technique for partial arthrodesis of the wrist. This operation is indicated in the treatment of certain forms of triquetro-lunate instability and represents a new approach to the treatment of Decoulx's stages I and II of Kienböck's disease. The incision is medial and limited. The use of a special trephine guided by a pine allows the extraction of a triquetro-lunate osteocartilaginous cylinder. A cancellous bone graft is then performed to fill in the loss of substance. This new, simple surgical procedure, but demanding in terms of its technique, should decrease the failure rate and should improve the chances of lunate revascularisation.

Arthrodesis↗
PubMed2002

Big-bubble technique to bare Descemet's membrane in anterior lamellar keratoplasty.

We describe a lamellar keratoplasty technique to bare Descemet's membrane in which air is injected to detach the central Descemet's. After a partial-thickness corneal trephination is performed, a disposable needle is inserted, deeply and bevel down, into the paracentral corneal stroma and air is injected. In most cases, this forms a large air bubble between Descemet's membrane and the corneal stroma. After anterior lamellar keratectomy is performed, a small opening is made in the air bubble and the remaining stromal layers are lifted with an iris spatula, severed with a blade, and excised with scissors. This technique is faster, safer, and easier to perform than previous methods.

Air↗
PubMed2003

Microkeratome-assisted lamellar keratoplasty for keratoconus: stromal sandwich.

PURPOSE: To evaluate microkeratome-assisted lamellar keratoplasty for the treatment of keratoconus when it is not possible to correct the astigmatic ametropia with contact lenses. SETTING: Ophthalmology Department, School of Medicine, Gazi University, Ankara, Turkey. METHODS: This prospective study comprised 9 eyes of 7 keratoconus patients with contact lens intolerance. The donor cornea was prepared with a microkeratome and punched with a 7.25 mm or 7.50 mm trephine. Following the creation of a standard 9.0 mm corneal flap in the host cornea, the donor stromal button was implanted under this corneal flap like a sandwich. Transepithelial photorefractive keratectomy or laser in situ keratomileusis was performed when the corneal topography and refraction stabilized by the end of the sixth postoperative month. Follow-up ranged from 7 to 22 months. RESULTS: All patients gained 5 or more lines (mean 7.2 lines +/- 1.6 [SD]), and no patient lost a line of vision. The mean corneal thickness was 432.7 +/- 36.1 micrometers preoperatively and 578.1 +/- 45.1 micrometers after refractive surgery. CONCLUSION: The early visual results of this surgical technique are promising and seem to be comparable to those with penetrating keratoplasty.

Adult↗
PubMed1993

Corneal incision dehiscence during penetrating keratoplasty nine years after radial keratotomy.

As the use of radial keratotomy (RK) to correct myopia increases, more patients are having penetrating keratoplasty (PK). Radial keratotomy incisions are known to show incomplete wound healing. When the radial corneal RK incisions are cut by the corneal trephine, the peripheral part of each incision may open, even years after surgery. In this case, a 56-year-old man had visual distortion and diplopia in one eye nine years after RK. Contact lenses did not correct the problem, and the patient could not tolerate the contact lenses. Penetrating keratoplasty was performed. During surgery about one-third of the peripheral RK incisions spontaneously opened, making suturing difficult. Although the final visual result was 20/20 corrected acuity, this case shows that RK incisions may remain incompletely healed and easily open during PK surgery as long as nine years after the RK surgery.

Cornea↗
PubMed1993

Corneal endothelial cell transplantation using Descemet's membrane as a carrier.

Rabbit corneal endothelial cells were transplanted into the right eyes of four New Zealand white rabbits using bovine Descemet's membrane as a cell carrier. Descemet's membranes were dissected from cow eyes, flattened on 36 mm culture dishes, and cut into discs with a 6 mm trephine. Rabbit corneal endothelial cells were seeded onto the discs and maintained in tissue culture conditions for seven days until a complete monolayer with a cell density of 3,000 cells/mm2 was formed. Before transplantation, corneal edema was induced in the host animals by an endothelial scrape wound, which removed the corneal endothelium. Five weeks later, the animals were prepared for transplantation. A corneal button was cut and placed on a dissection table so the host Descemet's membrane could be removed. The donor Descemet's membrane with a complete monolayer of rabbit corneal endothelial cells was placed on the stroma of the corneal button. To keep the donor membrane in place, the button was cauterized at three peripheral points and sutured back into the host eye. Prednisolone sodium phosphate eyedrops and dexamethasone eyedrops and ointment were applied twice daily during the post-operative period. All grafts stayed clear for a period of 12 to 17 weeks. This study shows the potential for using Descemet's membrane as a carrier for corneal endothelial cell transplantation.

Animals↗
PubMed1988

Effect of penetrating keratoplasty using grafts of various sizes on keratoconic myopia and astigmatism.

The records of 72 consecutive keratoconic eyes undergoing penetrating keratoplasty were reviewed for changes in myopia and astigmatism. Ages of the patients averaged 32.7 years. All sutures were removed after three months. Follow-up average was 40.2 months. Results showed an average decrease in myopia of 6.63 diopters (D) in 60 eyes (82.86%) and an average increase in myopia of 1.88 D in 12 of 70 eyes (17.14%). The decrease/increase in myopia and postoperative astigmatism was compared for grafts equal to the opening, grafts smaller than the opening, and grafts larger than the opening. The largest average decrease in myopia was 13.86 D (range 6.63 to 20.00), which occurred when a graft smaller than the opening was used (P less than .01). This group also showed the least postoperative astigmatism (2.82 D) (P less than or equal to .01). From this study, it appears that the use of a graft 0.25 mm smaller than the trephine opening in the host (i.e., 7.50 mm graft/7.75 mm opening) for penetrating keratoplasty in keratoconus is justified. A prospective study is now in progress.

Adolescent↗
PubMed1988

Modified temporary keratoprosthesis in the triple procedure: a new surgical technique.

We present a new surgical technique for use in the triple procedure. After trephining the cornea, we sutured a temporary keratoprosthesis made of silicone rubber into the corneal bed. The prosthesis provided a clear view with excellent depth of focus. By creating an artificial anterior chamber, the operative procedure resembled a normal extracapsular cataract extraction procedure. The keratoprosthesis made complete aspiration of all cortical material easier.

Cataract Extraction↗
PubMedDate not supplied

Corneal tissue levels of topically applied ofloxacin.

PURPOSE: To evaluate the levels of ofloxacin (Ocuflox) in human corneal tissue in patients exposed to various dosing regimens and application methods. SETTING: Corneal Consultants of Indiana, Indianapolis, Indiana, USA. METHODS: Forty patients meeting inclusion criteria were recruited from persons scheduled to have penetrating keratoplasty (PKP). Patients were placed into one of two study groups of 20 each based on dosing regimen and application method. The SAS GLM (General Linear Models) procedure was used to test for differences in mean Ocuflox tissue concentration among study groups and for interaction effects of preoperative diagnosis, trephine size, dosing regimen, and corneal integrity. RESULTS: Corneal tissue concentrations of Ocuflox were elevated significantly by varying drug application methods and dosing schedules before PKP. Eyes receiving medication every 15 minutes for 4 hours had significantly higher levels of Ocuflox than those receiving the drug in six doses over 24 hours before surgery. Ocuflox concentrations exceeded the MIC90 (minimum inhibitory concentration) for key ocular pathogens in essentially all cornea specimens studied. CONCLUSION: Ocuflox penetration was improved by administering it in a controlled setting at 15 minute intervals over 4 hours. The drug provided high tissue levels in both the cornea and aqueous humor, which together with its broad range of antibacterial coverage, should make it a good choice for prophylactic treatment.

Administration, Topical↗
PubMed1998

Price graft-over-host technique to manage positive pressure during penetrating keratoplasty.

Intraoperative positive pressure with resulting iris and lens prolapse can pose a difficult scenario during penetrating keratoplasty. In the Price graft-over-host technique, the graft is sutured across the trephinated host cornea, which maintains a formed anterior chamber and thus avoids intraoperative complications. The technique was used in 33 eyes, and no primary or secondary graft failures occurred. Eleven episodes of acute rejection in 11 eyes were treated successfully with steroids.

Adolescent↗
PubMed1998

Live-epikeratophakia for keratoconus.

PURPOSE: To assess the clinical feasibility of refractive live-epikeratophakia (L-EPI) for early keratoconus to cap, rather than reverse, the ectatic cornea. SETTING: Eye Department, Martin-Luther-Hospital, Bochum, Germany. METHODS: Twenty-seven consecutive cases with keratoconus stage I-II had L-EPI. Lenticules were obtained from eye-bank eyes. The lenticules were cut on the artificial anterior chamber bench of the Barraquer-Krumeich-Swinger set. Optical power was generated over refractive dies to achieve postoperative emmetropia. The lenticule was sutured into a peripherally undermined 7.0 mm trephination with a double-running torque suture. RESULTS: Re-epithelialization was complete within 4 to 6 days. In all but three cases that had corneal ulcers and experienced partial melting of tissue following severe neurodermatitis, all lenticules remained stable during the 10 year follow-up. The 1 month spherical equivalent remained almost stable over the entire follow-up. There was no sign of progression of keratoconus as induced myopia or astigmatism indicated by keratometry readings. Mean best spectacle-corrected visual acuity (BSCVA) was 0.45 (n = 27) preoperatively and 0.19 (n = 25) at 1 week, 0.39 (n = 26) at 1 month, 0.53 (n = 20) at 6 months, 0.58 (n = 13) at 1 year, and 0.64 (n = 8) at 2 years. Preoperative BCVA was achieved or improved in 13 eyes at 1 month. Postoperative astigmatism was < or = 3.25 diopters. Neither rejection nor lenticule opacification was observed. CONCLUSIONS: Live-epikeratophakia is a safe and minimally invasive extraocular procedure suitable for keratoconus stage I-II. Progression of keratoconus may be arrested. If unsuccessful, the procedure is complementable and there is no interference with a later penetrating keratoplasty.

Cornea↗
PubMed1998

Relative strength of photodynamic biologic tissue glue in penetrating keratoplasty in cadaver eyes.

PURPOSE: To compare the relative strength of photodynamic biologic tissue glue (PBTG) with that of 10-0 nylon sutures in closing penetrating keratoplasty (PKP) wounds in cadaver eyes. SETTING: Corneal Research Laboratory, University of Chicago, Chicago, Illinois, USA. METHODS: A 7 mm central corneal trephination was performed on 8 recently enucleated human eyes. Each corneal button was removed and then resutured in its original position, using 4 interrupted 10-0 nylon cardinal sutures and PBTG (n = 7) or 16 interrupted 10-0 nylon sutures (n = 1). Wound leak and incisional bursting pressures were determined. RESULTS: The average pressure at which wound leak and iris prolapse occurred was 124 mm Hg (range 70 to 180) and 185 mm Hg (range 90 to 300), respectively. The pressure required to create wound leak increased as the time between glue application and pressurization of the globe lengthened (mean 22 minutes, range 5 to 60 minutes), indicating that the bonding and stability of the adhesive increased with time. In contrast, the control eye developed wound leak at 70 mm Hg and iris prolapse at 300 mm Hg. CONCLUSIONS: Photodynamic biologic tissue glue was comparable to sutures in providing adequate corneal wound strength in PKP in a cadaver eye model. Wound closure with PBTG may reduce the number of sutures required in corneal transplantation and decrease the incidence of suture-related complications and allograft rejection.

Cadaver↗
PubMed1993

Influence of three alloplastic materials on calvarial bone healing. An experimental evaluation of HTR-polymer, lactomer beads, and a carrier gel.

This study evaluated experimentally three alloplastic materials (HTR-polymer, lactomer beads, and a resorbable gel substance). A bioassay performed in a critical size defect rat model disclosed no osteoinductive capacity of any material. A total of 72 trephine calvarial 5-mm defects were created in 18 rabbits. The inlays were tested relative to control (empty) defects in a varied pattern, and the results were assessed by light microscopy and contact radiography after 4 and 15 weeks. The HTR-polymer alone or combined with bone chips displayed the most rapid early bone regeneration and more mature bone marrow redevelopment. The present form of the gel material seems to be less suitable for use as a carrier substance because of the intense inflammatory response produced.

Animals↗
PubMed1988

Algae-derived (phycogene) hydroxylapatite. A comparative histological study [corrected and issued with original paging in Int J Oral Maxillofac Surg 1988 Oct;17(5)].

3 granular hydroxylapatite (HA) biomaterials, solid, coralline and phycogene HA (obtained from calcifying algae), differing widely in their relative amounts of specific surfaces and their origin, were examined with regard to their effects on bone healing in rats. Trephine drill holes were produced in the rat femur and filled with the HA granules. Each biomaterial produced a characteristic pattern of bone healing. Bioceramics with a small surface area showed random bone-implant contacts. Biomaterials offering large surface areas showed a dense bone-implant interface. Evidence is presented to suggest that a large specific surface favours osteoneogenesis and cell spreading on and into an implant.

Animals↗
PubMed1997

Bone grafting to the maxillary sinuses, nasal floor and anterior maxilla in the atrophic edentulous maxilla. A two-stage technique.

This study presents the results from 20 consecutive patients treated with an autogenous bone graft from the iliac crest. In ten patients the graft was placed in the maxillary sinuses and the floor of the nose (inlay group). Ten patients, in addition to the inlay graft, had a corticocancellous bone block secured with mini-screws to the anterior maxillary ridge (inlay/onlay group). Endosteal implants (Brånemark) were placed six months after surgery. A total of 136 implants were placed, of which eight failed to integrate during the six-month healing period. A further 15 implants were lost during the follow-up period. For the inlay group the average follow-up period was 22 months and for the inlay/onlay group 19 months. Donor site morbidity was significantly less when iliac bone was harvested with a trephine (inlay group) than in patients treated with our routine procedure for bone harvesting (inlay/onlay group). Surgical technique, donor site morbidity, implant survival and patient acceptance are presented.

Adult↗